title: Hourly oral sodium chloride for the rapid and predictable treatment of hyponatremia.
abstract: Hypertonic NaCl is first-line therapy for acute, severe and symptomatic hyponatremia; however, its use is often restricted to the intensive care unit (ICU). A 35-year-old female inpatient with an optic chiasm glioma and ventriculoperitoneal shunt for hydrocephalus developed acute hyponatremia (sodium 122 mEq/l) perhaps coinciding with haloperidol treatment. The sum of her urinary sodium and potassium concentrations was markedly hypertonic vis-à-vis plasma; it was inferred that serum sodium concentration would continue to fall even in the complete absence of fluid intake. Intravenous (i.v.) 3% NaCl was recommended; however, a city-wide public health emergency precluded her transfer to the ICU. She was treated with hourly oral NaCl tablets in a dose calculated to deliver the equivalent of 0.5 ml/kg/h of 3% NaCl with an objective of increasing the serum sodium concentration by 6 mEq/l. She experienced a graded and predictable increase in serum sodium concentration. A slight overshoot to 129 mEq/l was rapidly corrected with 0.25 l of D5W, and she stabilized at 127 mEq/l. We conclude that hourly oral NaCl, in conjunction with careful monitoring of the serum sodium concentration, may provide an attractive alternative to i.v. 3% NaCl for selected patients with severe hyponatremia.
authors.forename: Eric
authors.initials: E
authors.lastname: Kerns
authors.forename: Shweta
authors.initials: S
authors.lastname: Patel
authors.forename: David M
authors.initials: DM
authors.lastname: Cohen
mesh_terms: D000284:Administration, Oral; D000328:Adult; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D005260:Female; D006220:Haloperidol / Q000627:therapeutic use; D006801:Humans; D006849:Hydrocephalus / Q000628:therapy; D007010:Hyponatremia / Q000188:drug therapy*; D009897:Optic Chiasm / Q000473:pathology; D020339:Optic Nerve Glioma / Q000150:complications; D011188:Potassium / Q000097:blood; D012964:Sodium / Q000097:blood; D012965:Sodium Chloride / Q000008:administration & dosage / Q000627:therapeutic use*; D013607:Tablets; D017287:Ventriculoperitoneal Shunt
chemical_list: D014151:Anti-Anxiety Agents; D013607:Tablets; D012965:Sodium Chloride; D012964:Sodium; D006220:Haloperidol; D011188:Potassium